MEDICARE: MARISSA HALEY WHITAKER NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LN0000X	Neonatal Nurse Practitioner	350579	NY
2	163WN0002X	Neonatal Intensive Care Registered Nurse	905039	NY

General Provider Information

NPI Number	:	1275305146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISSA HALEY WHITAKER NP

Provider Business Mailing Address
First Line	:	16 CHESTERBROOK LN
Second Line	:
City	:	PITTSFORD
State	:	NY
Zip	:	14534-4725
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 ELMWOOD AVE
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14642-0001
Country	:	US
Telephone Number	:	585-275-2267
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2023
Last Update Date	:	03/02/2026

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